Tremors and racing heart while sitting on couch.

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TellMeMore
Yes, I'm with you on feeling internal vibrations/tremors and then experiencing the high heart rate. It sounds so crazy to people that don't experience it, and it is a bit baffling. When I first reported the feeling to my GP (before Afib diagnosis), she gave me a strange look and said it must be gas. I knew she didn't really have a clue and wasn't interested in investigating. I used to get really jumpy when it happened (like jump out of bed jumpy), but now I try to stop myself, take a few relaxing breaths, and wait for the HR to come down. When I used to jump up, I think I made the heart reaction worse, and it would sometimes lead to afib/pvc's. I've been reading about the vagal nerve and its relationship with the heart, stomach, and intestines. I'm wondering if maybe the vagal nerve is causing muscles to spasm and that's what I'm feeling. I hope this helps to know others feel similar symptoms. You're not alone.

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Daisy
Did you ask your EP about Atrial Flutter? What you are describing sounds like that. It is a fast but regular rate yet it differs from ordinary tachycardia. Many of us have had it and it can be successfully treated with an ablation. I had both Afib and Aflutter, as many do, and my Kardia would report Tachycardia when it was actually flutter—it can’t distinguish. I went into my ablation in flutter and thankfully came out in normal sinus rhythm after Natale “chased arrhythmias around my heart” as they changed from Aflutter to Afib and back again.

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Rucan
So it will say normal sinus rhythm and tachycardia on the kardiamobile when it could actually be atrial flutter? My episodes are exhausting to the point of fainting with heart rate as high as 160BPM at times, But the kardiamobile always says "Normal Sinus Rythm" and Tachycardia.

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Rucan
So it will say normal sinus rhythm and tachycardia on the kardiamobile when it could actually be atrial flutter?

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GeorgeN

So it will say normal sinus rhythm and tachycardia on the kardiamobile when it could actually be atrial flutter?

Yes, flutter is hard to diagnose without a 12 lead ECG. The Kardia device uses the large beat to beat variability to diagnose afib. Flutter, on the other hand, has a very regular beat. The only time I personally see flutter is when I used to use a larger dose of flecainide to convert afib (I now use 1/3 less). With the larger dose, the afib would convert to flutter and then back to afib. Using a beat to beat recording heart rate monitor, recording for the whole episode, the flutter would look very regular in the midst of the chaotic afib. It would just be a high rate (say 130 BPM). I should note that my flutter is an assumption on my part as I never tested the hypothesis with a 12 lead. If I put a Kardia on during this time, it would likely say "tachycardia."

Years ago, a member, Mark, in the UK provided me with a bunch of graphs of beat to beat heart rate vs time (NOT ECG's) with various rhythms. [www.afibbers.org] If you look at p8 of the pdf, you see a good example of the lack of variability. This lack of variability which is caused by the AV node allowing ever 2nd, 3rd or 4th atrial signal through. Also, sometimes the flutter will change back & forth between 3:1 & 4:1 conduction, for example. There are some of those examples in the PDF.

The AV node, if not familiar, is between the atria & the ventricles. In afib, it blocks random signals, which is why afib ventricular rate has a random beat length. In flutter, it blocks the signals in a regular fashion.

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GeorgeN

So it will say normal sinus rhythm and tachycardia on the kardiamobile when it could actually be atrial flutter?

Yes, flutter is hard to diagnose without a 12 lead ECG. The Kardia device uses the large beat to beat variability to diagnose afib. Flutter, on the other hand, has a very regular beat. The only time I personally see flutter is when I used to use a larger dose of flecainide to convert afib (I now use 1/3 less). With the larger dose, the afib would convert to flutter and then back to afib. Using a beat to beat recording heart rate monitor, recording for the whole episode, the flutter would look very regular in the midst of the chaotic afib. It would just be a high rate (say 130 BPM). I should note that my flutter is an assumption on my part as I never tested the hypothesis with a 12 lead. If I put a Kardia on during this time, it would likely say "tachycardia."

Years ago, a member, Mark, in the UK provided me with a bunch of graphs of beat to beat heart rate vs time (NOT ECG's) with various rhythms. [www.afibbers.org] If you look at p8 of the pdf, you see a good example of the lack of variability. This lack of variability which is caused by the AV node allowing ever 2nd, 3rd or 4th atrial signal through. Also, sometimes the flutter will change back & forth between 3:1 & 4:1 conduction, for example. There are some of those examples in the PDF.

The AV node, if not familiar, is between the atria & the ventricles. In afib, it blocks random signals, which is why afib ventricular rate has a random beat length. In flutter, it blocks the signals in a regular fashion.

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Daisy
Did you ask your EP about Atrial Flutter? What you are describing sounds like that. It is a fast but regular rate yet it differs from ordinary tachycardia. Many of us have had it and it can be successfully treated with an ablation. I had both Afib and Aflutter, as many do, and my Kardia would report Tachycardia when it was actually flutter—it can’t distinguish. I went into my ablation in flutter and thankfully came out in normal sinus rhythm after Natale “chased arrhythmias around my heart” as they changed from Aflutter to Afib and back again.

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Rucan
When I get these attacks my heart rate stays generally no higher than 160 BPM but usually 125-140 BPM. Could those beats per minute rate still be Aflutter?

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GeorgeN

When I get these attacks my heart rate stays generally no higher than 160 BPM but usually 125-140 BPM. Could those beats per minute rate still be Aflutter?

Sure. Let's assume the atria are beating 300 BPM in flutter. Then with 2:1 conduction through the AV node, then the ventricular rate is 150 BPM. 3:1 would be 100 BPM and 4:1 would be 75. Now the atrial rate of 300 is an assumption, which could be different - higher or lower, but the math is the same. If we assumed 350 BPM, then 2:1 would be 175, 3:1 would be 116 and 4:1 would be 87.5. Now there is no reason the atria would be beating at an even number, but you get the point. In my case, many times the rate in flutter was in the 130's.

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Daisy
Flutter rates can vary a great deal, sometimes not much higher than your normal resting HR and sometimes clocking in at over 200.

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Daisy

So it will say normal sinus rhythm and tachycardia on the kardiamobile when it could actually be atrial flutter? My episodes are exhausting to the point of fainting with heart rate as high as 160BPM at times, But the kardiamobile always says "Normal Sinus Rythm" and Tachycardia.

Yes, Kardia can’t differentiate between Flutter and Tachycardia — it will label both Tachycardia. Flutter often has very high rates and can feel exhausting. It takes a 12 lead EKG and an experienced EP to diagnose Flutter.

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Rucan
In this article here, isn't it saying that Kardiamobile can detect Aflutter? [pubmed.ncbi.nlm.nih.gov]

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Both 12-lead and KM ECG records were analyzed by three independent teams comprised of two cardiologists each. ECG interpretation was carried out according to a previously elaborated online form, consistent with the Polish ECG Description Guidelines [1], which required assessment of the following: ECG quality (good, acceptable, poor), rhythm (sinus rhythm, AF, atrial flutter [AFl] or pacemaker rhythm), presence of pathological Q wave as well as PQ, RR and QT measurements. In order to avoid cognitive and measurement bias, all KM ECG records were printed out in 1:1 ratio and assessed in paper-based form

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GeorgeN

In this article here, isn't it saying that Kardiamobile can detect Aflutter? [pubmed.ncbi.nlm.nih.gov]

Yes, it states it is non inferior for diagnosing flutter. However, in the full paper: [www.ncbi.nlm.nih.gov] in Table 1, none of the patients were listed as having a prior flutter diagnosis. Furthermore, as I read the paper, they used 3 expert human teams of two people each to analyze the 12 lead ECGs as well as the Kardia ECGs and are not comparing the Kardia analysis algorithm. What they are comparing is how good is a paper printed ECG for a 12 lead device vs a paper printed ECG captured by a Kardia, for expert human analysis.

Both 12-lead and KM ECG records were analyzed by three independent teams comprised of two cardiologists each. ECG interpretation was carried out according to a previously elaborated online form, consistent with the Polish ECG Description Guidelines [1], which required assessment of the following: ECG quality (good, acceptable, poor), rhythm (sinus rhythm, AF, atrial flutter or pacemaker rhythm), presence of pathological Q wave as well as PQ, RR and QT measurements. In order to avoid cognitive and measurement bias, all KM ECG records were printed out in 1:1 ratio and assessed in paper-based form

They also don't list how many patients were diagnosed as presenting with flutter. It could be one patient and the ECG analysis teams agreed the person had flutter. They only state 100% sensitivity and specificity for flutter.

Perhaps Moderator Carey will comment. He was an EMT for many years, so a lot of professional experience looking at ECGs. As well, he had a lot of flutter personally, so experience looking at his own. I recall he has previously commented that, even with a 12 lead, flutter is difficult to diagnose and takes an experienced EP. Here is one comment he made: [www.afibbers.org]

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GeorgeN
Perhaps Moderator Carey will comment. He was an EMT for many years, so a lot of professional experience looking at ECGs. As well, he had a lot of flutter personally, so experience looking at his own. I recall he has previously commented that, even with a 12 lead, flutter is difficult to diagnose and takes an experienced EP. Here is one comment he made: [www.afibbers.org]

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The KardiaMobile 6L device is the first and only six-lead personal ECG cleared by the FDA. It detects more arrhythmias than any other personal ECG device. KardiaMobile 6L provides instant detection of Atrial Fibrillation, Bradycardia, Tachycardia, Sinus Rhythm with Supraventricular Ectopy, Sinus Rhythm with Premature Ventricular Contractions, Sinus Rhythm with Wide QRS and Normal Heart Rhythm in an ECG.

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Carey

Perhaps Moderator Carey will comment. He was an EMT for many years, so a lot of professional experience looking at ECGs. As well, he had a lot of flutter personally, so experience looking at his own. I recall he has previously commented that, even with a 12 lead, flutter is difficult to diagnose and takes an experienced EP. Here is one comment he made: [www.afibbers.org]

Not much more to add. You and Daisy have covered it pretty well. You can lookup flutter and see examples of how to recognize it on an ECG, but at least with the flutter I've seen, which is hundreds of examples (most my own), it's rarely as patently obvious as the textbook examples. I've had a cardiologist and an ER doc stand in front of me and disagree over one of my ECGs. I've had more than one EP admit they couldn't be sure what they were looking at was flutter, especially once I discovered there is a rare beast known as flutter with a variable rate. It looks like afib at first glance because it's not rock solid regular, but on closer examination I could see multiple P waves between each QRS in certain leads, and that's the true diagnostic sign of flutter.

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Daisy
Kardia Mobile also doesn’t even have a diagnostic criteria for Flutter. From their website here is what it can report:

The KardiaMobile 6L device is the first and only six-lead personal ECG cleared by the FDA. It detects more arrhythmias than any other personal ECG device. KardiaMobile 6L provides instant detection of Atrial Fibrillation, Bradycardia, Tachycardia, Sinus Rhythm with Supraventricular Ectopy, Sinus Rhythm with Premature Ventricular Contractions, Sinus Rhythm with Wide QRS and Normal Heart Rhythm in an ECG.

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Shiny Sleeves
I but it was sudden and severe and scary. So yeah there can be some impending doom feelings that go along with it.

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Rucan
No one has found the arrhythmia yet.

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GeorgeN

No one has found the arrhythmia yet.

Have they had you on a 2 week or one month monitor that they can interrogate yet? Many of the monitors they use are single lead. In your case a multi lead monitor might make more sense for being able to diagnose the rhythms.

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Daisy
Did you ask your EP about Atrial Flutter? What you are describing sounds like that. It is a fast but regular rate yet it differs from ordinary tachycardia. Many of us have had it and it can be successfully treated with an ablation. I had both Afib and Aflutter, as many do, and my Kardia would report Tachycardia when it was actually flutter—it can’t distinguish. I went into my ablation in flutter and thankfully came out in normal sinus rhythm after Natale “chased arrhythmias around my heart” as they changed from Aflutter to Afib and back again.

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Rucan
I have asked my Cardiologist about Aflutter and he said it would have showed up on the Kardia mobile results which I provide him.

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Carey

I have asked my Cardiologist about Aflutter and he said it would have showed up on the Kardia mobile results which I provide him.

No, it would not have showed up. They should know that. Probably most of the members here know that and none of us are doctors, much less cardiologists.

You need a new cardiologist, preferably an EP.